Provider Demographics
NPI:1215218102
Name:TIMBERLINE REHABILITATION SERVICES, PS
Entity Type:Organization
Organization Name:TIMBERLINE REHABILITATION SERVICES, PS
Other - Org Name:TIMBERLINE PHYSICAL THERAPY, TIMBERLINE NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.P.T.
Authorized Official - Prefix:MR
Authorized Official - First Name:ZANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:360-567-2002
Mailing Address - Street 1:920 NE 112TH AV
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5104
Mailing Address - Country:US
Mailing Address - Phone:360-567-2002
Mailing Address - Fax:360-567-2005
Practice Address - Street 1:920 NE 112TH AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5104
Practice Address - Country:US
Practice Address - Phone:360-567-2002
Practice Address - Fax:360-567-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000430002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH99310Medicare UPIN